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JAI+F-31-2083 15244 P.es/w <br /> w©RK ORDER#. 03-E 0 - [0 M °I 2 <br /> Cooler of <br /> SAMPLE RECEIPT FORM <br /> CLIENT: NVF- DATE:— <br /> TEMPERATURE—SAMPLES RECEIVED BY: <br /> CALSCIENCL COURIER: LABORATORY(00W than CaleclonCQ CourWj: <br /> ChMed,cooler with temperature blank provided C Temperature blank. <br /> ChSed,cooler wlthcut twnpe-A"blank. °C IR Vmmometer <br /> Chilled and placed in coder With wet Ice Ambient temperature. <br /> Ambient and placed In cooler with wet ice <br /> Ambienttemperakwe. <br /> °C Temperature blank. Initial: <br /> CUSTODY SEAL INTACT: <br /> Sample(s): Cooler '� No(Not Intact)' Not Applicable(WA). <br /> Initial• <br /> SAMPLE CONDMON: <br /> Y� No WA <br /> Chaki�a-Custody document(s)received with samples . . ... <br /> Sample contalner lebal(e)conslatent with*A t *papers. <br /> Sample oont8krer(s)Intact and good condition.. el .. <br /> Correct containers for analyses requested .. . .. .. ' .... <br /> Proper preservation noted on sample label(s) <br /> VOA vnel(s)tree of headspaoe <br /> Tedtar bag(s)free of condensation .. ..... _ .. . ..... ..... <br /> Initis!: <br /> COMMENTS: <br />